Parental Technology Use Consent Form
Please complete this form to provide and confirm your consent for your child’s use of technology. All information is required to process your consent.
Parent/Guardian Full Name
*
First Name
Last Name
Relationship to Child
*
Please Select
Mother
Father
Legal Guardian
Other
Child’s Full Name
*
First Name
Last Name
Child’s Age
*
Parent/Guardian Email Address
*
example@example.com
Date of Consent
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Terms of Technology Use
*
Signature of Parent/Guardian
*
Submit Consent
Submit Consent
Should be Empty: